Abstract Body: Introduction: A strong association exists between diabetes mellitus (DM) and cardiac arrest particularly due to endothelial dysfunction induced by high blood glucose levels and lipid abnormalities prompted by insulin resistance. These pathophysiological changes result in heart structural changes and conduction abnormalities causing sudden death. The purpose of this study was to assess the trends and regional differences in cardiac arrest related mortality among DM patients in the U.S.

Methods: Mortality related data from the CDC WONDER database was examined for adults aged 25+ years from 1999 to 2023 for cardiac arrest related mortality using ICD-10 codes (I46.0, I46.1 and I46.9) among patients with DM (E10-E14). CDC database calculated the Age adjusted mortality rates (AAMR) per 100,000 persons. Joinpoint statistical software estimated annual percentage changes (AAPC) with statistical significance defined as 95% confidence interval (CI) excluding zero(P<0.05).

Results: Between 1999 and 2023, 1,095,268 people with DM died from sudden cardiac arrest. The AAMR declined from 21.30 in 1999 to 18.39 in 2018 (APC: -0.92), after which it increased to 23.90 in 2021 (APC: 11.35). From 2021 onwards, the AAMR showed a decrease to 18.72 in 2023 (APC: -12.08). Males had consistently higher AAMRs as compared to females throughout the study period. In males, the AAMR changed from 24.37 in 1999 to 24.13 in 2023 (AAPC: 0.0092) and in females, it changed from 19.10 to 14.26 (AAPC: -1.12). Non-Hispanic (NH) African American people had the highest overall average AAMR (37.34), while the lowest was observed in NH whites (15.90). Individuals aged 65+ had the highest overall AAMRs with an average of 22.56. The highest average AAMR was observed in West (28.99) and lowest in Midwest (12.23). Data limited to 2020 showed that metropolitan areas had significantly higher overall AAMR (19.51) than nonmetropolitan areas (18.72). States in the top percentile included Mississippi, California and New York.

Conclusion: Mortality remains disproportionately high among males, older adults, African Americans, and residents of western U.S. regions. These findings highlight the need for targeted prevention strategies addressing demographic and geographic inequities in cardiac outcomes among diabetic populations. Strict glycemic control with lifestyle modification can play a substantial role in reducing mortality rates.